Alvarado Score Calculator
Calculate the Alvarado appendicitis score from clinical signs, symptoms, and lab values in real time.
What Is the Alvarado Score?
The Alvarado score (MANTRELS score) estimates the probability of acute appendicitis using eight clinical and laboratory criteria. It helps emergency clinicians decide whether observation, imaging, or surgery is appropriate. Pair it with the Acid Base Calculator when evaluating systemic illness.
Scoring Criteria
Each finding contributes points toward a maximum score of 10:
- RLQ tenderness — 2 points
- WBC > 10,000/mm³ — 2 points
- Rebound tenderness, elevated temperature, pain migration, anorexia, nausea/vomiting, or left shift — 1 point each
Interpretation
Scores 0–4 suggest low appendicitis probability. Scores 5–6 are intermediate and warrant further workup. Scores 7–10 suggest high probability and often prompt surgical consultation.
Frequently Asked Questions
What is a normal Alvarado score?
There is no normal score — lower values (0–4) indicate low appendicitis probability, while higher values increase clinical concern.
Can the Alvarado score rule out appendicitis?
Low scores reduce likelihood but do not eliminate appendicitis. Clinical judgment and imaging may still be needed.
What does left shift mean in the Alvarado score?
Left shift refers to neutrophil predominance, typically more than 75% segmented neutrophils on the differential count.
Is imaging always required?
Not always. Intermediate scores often lead to ultrasound or CT, while very high scores may prompt direct surgical evaluation.
Does this replace clinical assessment?
No. The Alvarado score supports decision-making but cannot replace physical examination and clinician judgment.
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